NBSTSA CSFA Exam Questions

Correct answer: Vicryl

Vicryl is the best choice for subcutaneous closure because it is a synthetic absorbable suture that causes minimal tissue reaction and is absorbed by the body over time, promoting healing. This reduces the risk of chronic inflammation and foreign body reactions, making it optimal for this purpose.

Silk is not suitable for subcutaneous closure as it is non-absorbable and tends to provoke a more significant tissue reaction. Nylon is also non-absorbable and is primarily used for skin closure rather than subcutaneous tissue. Stainless steel wire is highly reactive and not appropriate for subcutaneous closures due to its lack of absorption and potential to cause considerable tissue irritation.

Correct answer: Sponge retention

The primary concern related to the use of multiple sponges during prolonged surgery is sponge retention. Retained sponges can cause serious complications, including infection and the need for additional surgeries. Proper counting and documentation of sponges are essential to prevent this risk.

Excessive absorption of fluids by sponges, compression of surrounding organs, and difficulty in achieving hemostasis are also potential concerns, but they are less critical compared to the risk of retained sponges. While these factors can impact surgical outcomes, preventing sponge retention is the most important consideration to ensure patient safety.

Correct answer: To remove debris and reduce bacterial load

Removing debris and reducing bacterial load is the primary goal of irrigation during a laparotomy to ensure a clean surgical field, thereby reducing the risk of postoperative infections and promoting optimal healing.

Cooling down tissues is not necessary during a laparotomy and is not the purpose of irrigation. Inflating the cavity is not the purpose of irrigation and is not related to a laparotomy. Reducing inflammation from wound closure is not directly addressed by irrigation.

Correct answer: Multiple myeloma

Multiple myeloma is a hematological malignancy of plasma cells characterized by the production of abnormal antibodies and various cytokines that lead to the activation of osteoclasts. These activated osteoclasts increase bone resorption, resulting in lytic bone lesions. The skeletal complications of multiple myeloma are primarily due to these lytic lesions, making it the cancer most associated with this phenomenon.

While breast cancer, lung cancer, and colon cancer can metastasize to bone, they are not as classically associated with lytic bone lesions as multiple myeloma. Breast cancer metastasis often results in blastic or mixed lesions due to the stimulation of osteoblasts.

Lung cancer may cause lytic lesions, but it is more often associated with a combination of blastic and lytic changes in the bone.

Colon cancer metastasis to bone is uncommon and usually presents as sclerotic lesions. While these cancers can affect the bone, multiple myeloma is distinct in its association with lytic lesions due to its direct impact on bone resorption processes.

Correct answer: The weight capacity of the equipment

When selecting positioning equipment for a patient undergoing a lengthy surgical procedure, the weight capacity of the equipment is most important. This ensures the equipment can safely support the patient for the entire duration of the surgery, thereby preventing any potential failures or complications related to overloading the equipment.

While the type of materials used in the equipment affects durability and ease of maintenance, it is not as critical as ensuring the equipment can handle the patient’s weight.

Similarly, the brand of the equipment may indicate quality and reliability, but this should not take precedence over the fundamental requirement of weight capacity.

The duration of the procedure is a factor in overall planning but does not directly impact the necessity for equipment that can adequately support the patient’s weight.

Correct answer: Nasal cavity

The nasal cavity plays a crucial role in conditioning the air we breathe by humidifying and warming it. The rich blood supply within the nasal passages helps to heat the air while the mucus lining adds moisture ensuring that the air reaching the lungs is at an appropriate temperature and humidity level. This process is essential for protecting the delicate tissues of the respiratory system and facilitating efficient gas exchange.

The alveoli are critical for gas exchange but do not contribute to the humidification or warming of air.

Bronchioles are small passages within the lungs and also do not play a significant role in conditioning the air.

The larynx primarily functions in sound production and airway protection during swallowing. It does not specifically provide involvement in modifying the temperature or humidity of inhaled air.

Correct answer: Vancomycin

Vancomycin is a glycopeptide antibiotic that does not belong to the penicillin class of antibiotics, making it a safe choice for patients with penicillin allergies. It is used to treat various infections, including those resistant to other antibiotics. Because vancomycin's structure is distinct from penicillin, it does not typically trigger allergic reactions in patients with penicillin allergies, making it a valuable alternative in surgical prophylaxis and treatment when penicillin cannot be used.

Cephalexin, a cephalosporin, shares structural similarities with penicillin, leading to possible allergic reactions in penicillin-sensitive patients, especially when first-generation cephalosporins are used.

Amoxicillin and ampicillin are both beta-lactam antibiotics within the penicillin family and should be strictly avoided in patients with a history of penicillin allergy due to the high likelihood of allergic response.

Correct answer: Calcaneus

The calcaneus is the bone least likely to be involved in a trimalleolar fracture. A trimalleolar fracture involves the three malleoli: the medial malleolus of the tibia, the lateral malleolus of the fibula, and the posterior malleolus of the tibia or talus. The calcaneus, located below the talus, serves as the heel bone and is not involved in the ankle joint's structural components that are typically fractured in trimalleolar injuries.

In contrast, the talus, tibia, and fibula are all directly involved in the formation of the ankle joint and are the primary bones affected in a trimalleolar fracture. The talus acts as a connecting bone between the tibia and fibula, while the medial and lateral malleoli of the tibia and fibula respectively form the bony prominences on either side of the ankle. These bones are subjected to significant stress during a trimalleolar fracture, resulting in their involvement.

Correct answer: The patient receives a detailed explanation of the procedure and signs the consent form.

Informed consent in surgical patient care is best illustrated by the patient receiving a detailed explanation of the procedure and then signing the consent form. This process ensures that the patient fully understands what the procedure entails, including the associated risks and benefits, and agrees to proceed.

Verbal agreements and signatures without proper discussion do not meet the criteria for informed consent. These actions fail to ensure that the patient is adequately informed, which is a fundamental aspect of ethical medical practice. A family member signing on behalf of the patient without the patient's understanding compromises the patient's autonomy and fails to respect their right to make informed decisions about their own care.

Correct answer: Applying traction to the fundus of the gallbladder

Applying traction to the fundus of the gallbladder is most appropriate because it helps to elevate and expose the gallbladder, making dissection around it easier and safer. This maneuver directly improves visualization and access to the gallbladder.

Placing the patient in the Trendelenburg position is not typically used for this purpose; a reverse Trendelenburg position may be more helpful. Using a Babcock forceps to grasp the common bile duct is inappropriate and risks damage. Applying counter-traction to the liver would not be as effective as direct traction on the gallbladder.

Correct answer: Babcock forceps

Babcock forceps are most appropriate for providing traction on the thyroid gland without causing tissue damage due to their atraumatic design. This ensures that the delicate thyroid tissue is handled gently, reducing the risk of complications.

The Lahey tenaculum, while potentially used for holding and manipulating tissues during surgery on the thyroid, can cause more tissue trauma compared to Babcock forceps. Allis clamps have teeth that can damage the delicate thyroid tissue, making them less ideal for this purpose. Kocher clamps, used for grasping tougher tissues, can cause significant damage to the thyroid gland due to its delicate nature.

Correct answer: Oculomotor nerve (CN III)

The oculomotor nerve (CN III) is crucial for controlling most of the eye's movements as it innervates multiple extrinsic muscles including the superior, medial, and inferior rectus muscles and the inferior oblique muscle. Additionally, it is involved in pupil constriction and maintaining an open eyelid via the levator palpebrae superioris muscle. Severing this nerve leads to significant deficits in eye movement, drooping eyelid (ptosis), and a dilated pupil.

The optic nerve (CN II) solely transmits visual information to the brain and does not innervate any muscles, hence its severance affects vision rather than movement.

The trochlear nerve (CN IV) controls only the superior oblique muscle, making its impact on overall eye movement limited.

The abducens nerve (CN VI) affects only the lateral rectus muscle, influencing only horizontal movement, and thus does not have a broad impact on eye muscle control.

Correct answer: Scalpel

A scalpel is the instrument typically used to remove necrotic tissue during a debridement procedure. It allows for precise cutting and removal of dead tissue, which is essential for effective debridement.

A hemostat is designed for clamping blood vessels and lacks the precision needed for debridement.

Metzenbaum scissors, though used for cutting delicate tissue, are not suitable for removing necrotic tissue.

Adson forceps are used to grasp tissue but do not have the capability to excise necrotic tissue effectively.

Correct answer: Subcuticular sutures with absorbable material

Subcuticular sutures with absorbable material are the preferred method for pediatric skin closure because they reduce scarring and trauma. These sutures are placed under the skin, where they support healing and dissolve naturally, avoiding the need for removal and minimizing cosmetic concerns.

Interrupted silk sutures can increase scarring. They also require removal, which can be distressing for children and should be avoided if possible. Staples, while quick to apply, leave more noticeable scars, making them less ideal for cosmetic outcomes. Nylon sutures also necessitate removal, causing additional discomfort and potential scarring.

Correct answer: Anaphylactic reaction

The sudden onset of urticaria, dyspnea, and hypotension after receiving an antibiotic strongly suggests an anaphylactic reaction. Anaphylaxis is a rapid and severe allergic reaction that can occur after exposure to certain medications, foods, or insect stings. Prompt recognition of anaphylaxis is crucial, as it is a life-threatening emergency that requires immediate administration of epinephrine, airway management, and supportive care to stabilize the patient.

Syncope involves fainting due to temporarily reduced blood flow to the brain and does not include allergic symptoms such as hives and respiratory distress.

Hyperventilation syndrome involves excessive breathing leading to low carbon dioxide levels but does not cause hypotension or urticaria.

Myocardial infarction involves cardiac symptoms such as chest pain and does not typically present with the rapid allergic symptoms observed here.

Correct answer: Check the power source and connections

The first step when a piece of surgical equipment fails to power on is to check the power source and connections. This initial troubleshooting can often resolve power issues quickly and efficiently, ensuring that the equipment is available for use as soon as possible.

Replacing the equipment immediately is not correct without first determining the cause of the problem. Informing the surgical team and tagging the equipment for maintenance is correct if the equipment cannot be turned on after checking connections, but these are steps that should follow initial troubleshooting. Checking power connections can often resolve the issue without the need for further intervention.

Correct answer: To provide continuous exposure of the operative site

The primary purpose of using a self-retaining retractor during abdominal surgery is to provide continuous exposure of the operative site. This allows the surgeon to work efficiently without needing to manually hold the retractor, facilitating a smoother surgical process.

The self-retaining retractor’s main role is to keep the surgical site open, not to maintain a sterile field. The retractor is not directly involved in reducing postoperative pain and may contribute to increased postoperative pain in some situations. Minimizing tissue injury is important, but it is not the purpose of the self-retaining retractor.

Correct answer: Glomerulus

The glomerulus, a specialized network of capillaries within the nephron, is crucial for blood filtration in the kidney. Blood enters the glomerulus, where filtration occurs as blood plasma is pushed through its capillary walls into the Bowman's capsule, initiating urine formation. This process efficiently filters out waste products and excess substances from the bloodstream while retaining essential components like proteins and blood cells.

The renal pelvis serves as a conduit for urine, directing it from the kidney into the ureter.

The ureter's function is to transport urine to the bladder, but it does not have a role in filtration.

The nephron encompasses the entire filtration system, but it is the glomerulus specifically that handles the initial blood filtration, distinguishing it from other parts of the nephron such as the tubules and collecting ducts.

Correct answer: Video laryngoscope

A video laryngoscope is an essential tool for managing difficult airway cases, as it provides enhanced visualization of the vocal cords and surrounding structures during intubation. This technology allows the anesthesiologist to have a better view of the airway, increasing the success rate of intubation in patients with challenging anatomical features.

A nasal cannula is designed for oxygen delivery and does not aid in intubation.

A Laryngeal Mask Airway (LMA) is used to secure an airway but does not facilitate direct laryngoscopy or visualization for difficult intubations.

An oropharyngeal airway helps maintain patency but is not a visualization tool for intubation.

Correct answer: Ensuring an airtight seal around the dressing

Ensuring an airtight seal around the dressing is crucial for the proper functioning of a wound VAC device immediately after application. This seal allows the device to maintain the necessary negative pressure, which is essential for removing excess fluid from the wound, reducing edema, and promoting wound healing effectively.

Applying heat to the wound area is not a standard practice and does not contribute to the function of a wound VAC device; it might even cause harm by damaging tissues or increasing swelling.

Keeping the dressing moist with saline is also not relevant, as the VAC system relies on negative pressure rather than moisture.

Moreover, removing the device every two hours would disrupt the continuous negative pressure required for effective wound healing and would not be recommended.